Sirikurnpiboon Siripong, Awapittaya Burin, Jivapaisarnpong Paiboon, Rattanachu-ek Thawee, Wannaprasert Jerasak, Panpimarnmas Sukij
J Med Assoc Thai. 2014 Nov;97 Suppl 11:S81-6.
Colonic stenting is now the preferred treatment either for palliation or as a bridge to surgery for obstructed colorectal cancer. It reduces complications from emergency surgery and the need for colostomy formation. However, stent perforation can lead to peritoneal tumor spillage, a higher rate of infection and changing the risk of a potentially curable disease to an incurable one. Therefore, it is important to study the optimum time for operation after stent insertion.
From January 2006 to January 2012, 30 cases of acute left-sided malignant colorectal obstruction were managed by expandable metallic stent (SEMS) as a bridge to surgery. In all, 19 males and 11 females with mean age of 60.07±12.19 years (range 40-80 years) were included in the study. The obstructed locations were 1 case at the transverse colon, 6 cases at the descending colon, 13 cases at the sigmoid colon, 5 cases at the upper third at the rectum and 5 cases involving the middle third of the rectum.
The perforation of SEMS was founded in 11 cases (36.67%). The mean bridging time before operation in the nonperforated group was 5.54 (±1.29) days shorter than in the perforated group, 10.54 (±4.82) days (p<0.001). All of the subjects in the perforated group reported clinical lower abdominal pain without sign of peritonitis, developed in an average 4.5 days (3-7 days).
The optimum bridging time for surgery should be within 5 days.
结肠支架置入术目前是缓解梗阻性结直肠癌症状或作为手术过渡的首选治疗方法。它可减少急诊手术的并发症以及结肠造口术的需求。然而，支架穿孔可导致腹膜肿瘤播散、更高的感染率，并将潜在可治愈疾病的风险转变为不可治愈疾病的风险。因此，研究支架置入术后的最佳手术时间很重要。
2006年1月至2012年1月，30例急性左侧恶性结直肠梗阻患者接受了可扩张金属支架（SEMS）置入术作为手术过渡。研究共纳入19例男性和11例女性，平均年龄60.07±12.19岁（范围40 - 80岁）。梗阻部位为横结肠1例、降结肠6例、乙状结肠13例、直肠上三分之一处5例、直肠中三分之一处5例。
11例（36.67%）发生SEMS穿孔。未穿孔组术前平均过渡时间比穿孔组短5.54（±1.29）天，分别为10.54（±4.82）天（p<0.001）。穿孔组所有患者均出现临床下腹部疼痛但无腹膜炎体征，平均在4.5天（3 - 7天）出现。
手术的最佳过渡时间应在5天内。
